Upper Limb
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
Knowing the organization of the brachial plexus (Figure 4.3) is critical for understanding the motor and cutaneous innervation of the upper limb. Many students memorize the brachial plexus using mnemonic devices, but most aspects of its organization can be more easily understood in the context of the evolutionary and developmental constraints of the body. For example, if an engineer without previous anatomical knowledge looked at the human body, some aspects of it would seem to make no sense. For example, nerves from ventral rami use peculiar—and often risky (subject to injury) “tricks” to get to the back of the body to innervate posterior pectoral shoulder muscles. To an engineer, it would seem to be much easier for nerves from dorsal rami to innervate those posterior (dorsal) muscles. However, the configuration of these nerves in the adult human makes complete sense if you take into account our developmental and evolutionary history, as explained in Section 4.3.
The spinal cord
Nan Stalker in Pain Control, 2018
The three main nerves of the brachial plexus are as follows. The radial nerve. This runs round the back of the humerus and down the outside of the forearm. It supplies the extensor muscles of the elbow, wrist and hand.The ulnar and median nerves. These run down the inside and middle of the limbs respectively and supply the flexor muscles of the wrist and hand. The ulnar nerve crosses in the groove between the back surface of the internal epicondyle of the humerus and the olecranon process.The thoracic nerves. These supply the muscles of the chest and the main part of the abdominal wall.
Treatment planning
Jing Cai, Joe Y. Chang, Fang-Fang Yin in Principles and Practice of Image-Guided Radiation Therapy of Lung Cancer, 2017
The brachial plexus is a nervous network that arises from the four lower-most cervical nerves and the first thoracic nerves. This network controls the sensation and motor function of the upper extremities. Radiation injury of the brachial plexus, or brachial plexopathy, may manifest as pain, paresthesia, or motor weakness. A 2012 retrospective study of patients with NSCLC undergoing conventionally fractionated RT with concurrent chemotherapy examining rates of brachial plexopathy found a strong association and higher rates of brachial plexopathy with median brachial plexus doses greater than 69 Gy and doses to 0.1 cm3 of brachial plexus greater than 75 Gy [84]. In a retrospective study from Indiana University looking at apical lung lesions treated with SBRT, a maximum brachial plexus dose of 26 Gy or greater was associated with significantly higher rates of brachial plexopathy. Current clinical trials recommend a maximum dose ≤63–66 Gy [79] with conventional fractionation. For SBRT, brachial plexus dose constraints include 17.5 Gy if single fraction, 24 Gy (8 Gy/fx) max with 3-fraction regimens, 27.2 Gy (6.8 Gy per fraction with 4-fraction regimens, and 32 Gy max (6.4 Gy/fx) with 5-fraction regimens [66].
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
Marie-Eve Pepin, Derek Chan
The use of a clinical decision-making model may be a helpful tool for making difficult clinical decisions. The purpose of this case report is to describe how an established clinical decision-making model was able to assist a physical therapist (PT) in making a diagnosis of Amyotrophic Neuralgia or Neuralgia Amyotrophy (NA). NA (also called Parsonage-Turner syndrome or brachial neuritis) is a rare clinical syndrome consisting of acute and severe pain affecting the shoulder and is often accompanied by shoulder or arm weakness. It is characterized by inflammation to one or more branches or cords of the brachial plexus (National Organization for Rare Disorders, 2005; van Alfen, 2007) and affects the long thoracic nerve and suprascapular nerves most commonly (Gupta, Winalski, and Sundaram, 2014). It is more common in men than women and incidence peaks around age 40. The etiology of NA is unknown, but an immune-mediated inflammatory reaction has been suggested as a possible cause (Feinberg and Radecki, 2010). Many factors including recent surgery, infections, recent immunization and immune or genetic susceptibilities can make the patient more prone to NA. Feinberg and Radecki (2010) reported that viral infections are the most common risk factor for NA while the second most common is recent immunization.
Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome
Published in The Physician and Sportsmedicine, 2022
Michael J. Gutman, Brian S. Gutman, Christopher D. Joyce, Jacob M. Kirsch, Matthew B. Sherman, Surena Namdari
Thoracic outlet syndrome (TOS) is a rare condition that occurs when there is compression of the subclavian artery, subclavian vein, or the brachial plexus [1–4]. Though multiple compressive structures are implicated in TOS, hypertrophic scalene or pectoralis minor muscles are most commonly seen in overhead athletes [1,5–8]. TOS can further be subdivided based on the compromised neurovascular structures such as arterial, venous, or neurogenic. Most cases of TOS are neurogenic, composing 95% of the cases, followed by venous thoracic outlet obstruction (VTOS) comprising 4% of the cases [2]. The C8 and T1 nerve roots are most commonly affected in neurogenic thoracic outlet syndrome (NTOS), causing paresthesia, weakness, and pain commonly involving multiple fingers. Symptoms in NTOS are typically worse with arm elevation [9]. These abnormal findings are not necessarily in a standard dermatomal pattern but rather to a region, such as the arm, hands, or fingers [3,10]. VTOS may present as either acute thrombosis or chronic intermittent obstruction [6,7].
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
The Brachial plexus is a large network of peripheral nerves arising from the cervicothoracic spine which provides motor and sensory functions to the upper extremities. The clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has been a longstanding diagnostic challenge, as history, physical examination findings and electrodiagnostic testing are frequently indeterminate in this domain. MR neurography (MRN) of the brachial plexus has emerged in recent years as a useful modality for the identification of brachial plexopathies in both pediatric and adult populations. The article discusses the current state of brachial plexus MRN, including recent advances and future directions, as well as illustrate adult and pediatric brachial plexopathies that can be optimally characterized using these techniques.
Related Knowledge Centers
- Spinal Cord
- Axilla
- Nerve Plexus
- Ventral Ramus of Spinal Nerve
- Cervical Spinal Nerve 5
- Cervical Spinal Nerve 6
- Cervical Spinal Nerve 7
- Cervical Spinal Nerve 8
- Thoracic Spinal Nerve 1
- Cervicoaxillary Canal